Good Medicine - Residency II
Copyright© 2025 by Michael Loucks
Chapter 64: All I Can Say at This Point Is We Are Where We Are
February 13, 1991, McKinley, Ohio
"What do surgeons use for birth control?" I asked Mary with a smirk when I saw her on Wednesday morning.
She rolled her eyes.
"The answer is 'their personality'," she said, "but I DARE you to say that's true about me!"
I chuckled, "Touchy, touchy!"
"I heard a new one about two Residents who met at a conference and had a one-night stand. It goes like this..."
When they awake in the morning, the male Resident says to the female Resident, "You must be a surgeon."
She replies, "How did you know?"
"You're very, very good with your hands!"
"Thanks! I bet you're an anesthesiologist."
"No way!" the guy exclaims. "How did you know?"
"I didn't feel a thing!"
I laughed hard at the joke.
"Who did you hear that from?" I asked.
"A female anesthesiology Resident. Hold up your hand for a sec, fingers together, palm facing me."
I had no idea what she was going for, but I was certain there would be some kind of joke associated with the motion, so I did as she asked.
"I'd say you never had that Resident's problem!" Mary declared.
"Seriously? The BS about hand size or shoe size?"
"Actually, no. A friend of mine from Chicago has a theory that men who have ring fingers longer than their index fingers are better endowed than those who don't. She says her experience and that of her friends has borne her out!"
"Interesting."
"She also says her extensive research shows guys with longer ring fingers are nicer than guys who don't have that trait."
"Also interesting."
"I can confirm the latter; care to confirm the former?" Mary asked with a smirk.
"«Это государственная тайна, товарищ» (Eto gosudarstvennaya tayna, tovarishch)!" I said with a grin.
"You'll have to translate that one!" Mary declared.
"It's a state secret, Comrade!" I chuckled. "Don't you have a place to be?"
"Yes! Home in a warm bubble bath! Have a good day!"
"You, too!"
She walked away, and I went into the lounge to find Len and Kevin so we could begin seeing patients. I was only able to see two patients before the Residency Board met to make our recommendations to Doctor Wernher about our Match list.
We'd interviewed a total of twenty-seven candidates for ten slots, and my first two choices were Mary Kealty and Len Godwin. That was the consensus of the group, with the only debate being which of the two to list first. In the end, it went the way I preferred, with Mary Kealty being listed first and Len Godwin second.
The other candidates were listed in order of their scores by the board, though even with eighteen of the twenty-seven listed, I suspected we might need a Scrambler or two. We'd know on March 11th how many positions filled, and who filled them, though we couldn't reveal that to any of the candidates, who'd be notified on March 14th.
"Mike, would you speak to Mary Kealty and Len Godwin?" Brent Williams asked. "You know the rules, but do your best to encourage them to list us first."
"I'll speak to both of them," I replied. "I'll go right up to the line!"
Len was simple because he was my student, so during an afternoon lull, I invited him to the consultation room.
"I hope you'll list us at the top of your Match list," I said.
"That's a no-brainer! I know you can't say anything more than what you just said, but don't worry. I want to Match here."
"I'm glad to hear that."
"Can I ask you about your change in status?"
"From the time I was ten, I wanted to work in the ED, and I allowed my mentor to talk me into considering surgery, but I didn't want to be a full-time surgeon. I heard of the new specialty of trauma surgery, and I offered it as a compromise, trying to make everyone happy. What I realized after eighteen months was that I was going to spend more than eighty percent of the next six or seven years in surgery, not treating patients in the ED. Because I was confident Mary was capable of taking over leadership of the system, I felt free to accept Doctor Wernher's invitation to switch my specialty."
"They told us that it was basically impossible to switch," Len said.
"That's true, but the one case where that can happen is when a Resident is dismissed who is at the same level. Technically, I'm taking Paul Lincoln's spot."
"He was screwed, wasn't he?"
"I cannot comment on that, but that is certainly a conclusion one could draw from the public information."
"Got it," he said with a knowing smile.
We returned to seeing patients, and about fifteen minutes before my shift ended, I placed a call to Mary Kealty. She wasn't available, so I left my home number and the ED number and asked her to return my call.
February 14, 1991, McKinley, Ohio
Mary Kealty returned my call on Thursday morning while I was with a patient, and consistent with the game of telephone tag, I returned the call to find she was unavailable. Finally, just before lunch, we managed to connect.
"What can I do for you, Doctor Mike?"
"Give me ten minutes to explain why I think you should list us at the top of your Match form."
"Make your sales pitch!"
"Around the time you arrive, or just after, we'll be a Level I Trauma Center, complete with a state-of-the-art emergency ward. Later this year, we'll break ground on a new, state-of-the-art surgical wing. You won't find a better group of physicians in any hospital in the area."
"Rebekah mentioned you had a study group and you were all planning to go to medical school together."
"We did, though only Clarissa Saunders and I chose to Match at Moore Memorial. She's in Internal Medicine."
"My fiancé said there was a lawsuit against your hospital that you lost, and it led to a doctor being fired."
"The reports in the Press were inaccurate, as they usually are. Just to be clear, we settled; we didn't lose. I was in the ED when the bounceback presented, I took him up for surgery, and I was in the OR when he coded, assisting with the surgery."
"Emergency medicine Residents assist with surgery?"
"I'm technically a trauma surgeon, a program I helped start here. I'm assigned to the ED."
"That explains the red scrubs — I only saw them when I was on the surgical floor."
"Yes. In any event, I testified during the trial, and I know, without any doubt, that we did nothing wrong and did nothing to contribute to the patient's death. Unfortunately, settlements are the norm and are driven more by politics, money, and expediency."
"So why would I risk Matching there?"
"Because you cannot escape that risk, no matter where you go. If you would like, I'll walk you through what happened."
"I'd like to hear it, but I don't have time right now. Could I call you this evening?"
"My band is playing a gig, which means I won't be home. If Sunday afternoon or evening works for you, it could be then."
"Sunday afternoon works."
"Call my home number, please."
"I will. Thanks."
After we said 'goodbye', I hung up and went to see Doctor Wernher.
"I spoke to Mary Kealty to encourage her to list us first, and she mentioned her fiancé had told her about the lawsuit and about Doctor Lincoln being dismissed. I have a call scheduled with her on Sunday afternoon. I have a larger concern, though."
"The fact that she mentioned it indicates others may know about it as well."
"Yes. If that's true, I'm going to revise my estimate and say we might only fill half our slots from direct Matches. Some students won't list us, and others will list us as, in effect, final contingent backups."
Doctor Wernher frowned, "I think someone needs to speak to as many of those students as possible."
"That might help, but it's difficult to get past the fact that Paul Lincoln was dismissed for doing something that was literally hospital policy. I said it was BS at the time, and that was before I realized it's going to negatively affect our ability to attract top students. I suspect that it won't only be in emergency medicine."
"What prompted you to call Miss Kealty?"
"Brent suggested I speak to both her and Len Godwin, as they were our top two candidates, to ensure they listed us first, within the limits of what I'm able to say per the rules."
"Take the complete list and start calling," Doctor Wernher said. "Be as persuasive as possible, but don't raise the situation with Paul Lincoln unless they do."
"I'd say 'obviously', but that might not be obvious to some people. Calling the eighteen we listed is going to take some time."
"Take yourself off the board for a few hours; I'll cover for you. Send your students to me."
"Will do."
I left his office and went to Brent to get the complete list of students, but my conversation with Mary left me with a sense of foreboding. If Moore Memorial were left, in effect, scraping the bottom of the barrel, we'd have our work cut out for us, and we might even end up in a situation where we had slots we didn't fill. That would create all manner of challenges for at least the next year, and might even have knock-on effects that lasted two or three years.
To have some privacy to make the calls, I went up to the surgical ward and asked permission to use one of the consultation rooms. Nurse Amy gave permission, so I went there and began making calls. I only reached half the students, and for the others, I left the ED phone number and requested they call back during my shifts, giving them the days and times.
Of the ones I did reach, four of them seemed relatively enthusiastic, though it was hard to judge if they'd list us first. The other four didn't seem nearly as enthusiastic, and unfortunately, three of those four were in our top ten picks. I did my utmost to sway them in our direction, but I couldn't make any commitments. When I completed the calls, I returned to the ED.
Dutch was in with a patient, so I waited for him to finish, then asked to speak to him and Brent Williams.
"I'm concerned," I said. "Four of our top ten picks are reluctant, though I believe I can sway Mary Kealty."
"Which ones?" Brent asked.
"Besides Mary Kealty, it's Michael Davis, Amanda Johnson, and David Anderson. Len Godwin is, I think, a sure thing. I left messages for eight others. My concern is that even if we list eighteen, we might come up three or four short. Given that, we have to ask ourselves if we should add some of the other nine to the list."
"I'm curious to hear your take," Dutch said.
"I wouldn't. If we didn't want to list them before, we shouldn't list them now. I believe we'd be better off taking Scramblers. There are always decent candidates who didn't Match because they didn't optimize their Match list or didn't list enough programs. We interviewed fewer than 1% of medical students."
"I agree with Doctor Mike," Brent said, following Dutch's protocol, which grated on me. "If we rejected them during the interview process, why would we want them now? We can take a second look if any of them have to Scramble, but I believe we should stand pat on our list of eighteen."
"I suspect that's the best approach," Dutch said. "We have time, so let's wait to see what Mike finds out, then consider if we should revise the list to change the order or add names."
Brent and I agreed, so we left Doctor Wernher's office to return to treating patients. That evening, Code Blue had our fairly regular monthly gig at Stirred Not Shaken, which went over well, as it usually did. Kris didn't join us given the restrictions, and when I arrived home, we had a very private Valentine's Day celebration.
February 17, 1991, McKinley, Ohio
By the time Mary Kealty called on Sunday, I had spoken to all of the medical students and concluded that, at best, seven of the eighteen would list us high enough to have a chance to Match at Moore Memorial. When Mary called, I walked her through the entire sequence of events, starting with Paul Lincoln seeing the patient.
"I don't have enough experience to judge whether anyone did anything wrong during the surgery," Mary said, "but it was absolutely wrong for the Resident to be dismissed when he followed the protocols that were in effect at the time."
"I'm going to take a chance and share something with you," I said. "What happened to Paul Lincoln was pure, unadulterated bullshit, and is a stain on the Hospital Board of Directors that will not wash off until all of them are replaced. Paul Lincoln was a sacrificial lamb, and I was, unfortunately, in no position to do much about what happened. That will not be true in the future.
"In June, I'm switching programs to Emergency Medicine, and I'll be Chief Resident. I have a commitment from Doctor Wernher for an Attending spot and a commitment to make me Chief Attending. I promise you, nothing like this will ever happen again, because if it does, I will make use of every tool in the toolbox, including the Press and any other way I have of preventing a huge injustice."
"I have to assume none of that is public."
"Correct. It's all between Dutch Wernher and me, though my «старец» (staretz) and my wife know." ("Spiritual Director")
"What is that word?"
"It's Russian, and the direct translation is 'Elder', but because that has connections for Protestants that are not even close to what it is, I usually translate it as 'Spiritual Director'. He's a monk at a Russian Orthodox monastery in Michigan."
"I was raised Roman Catholic, so I at least have half a clue about that, though let's just say that at seventeen I decided to do things of which the Roman Catholic Church didn't approve."
I chuckled, "Eighteen for me, but not for lack of trying before."
"I'm curious, and you obviously don't have to answer, but what would you have done if you were in that family's position?"
"I was in that family's position," I replied. "My wife died shortly after giving birth to my eldest daughter. She suffered an intraparenchymal bleed due to a congenital arteriovenous malformation. I assume you'll need me to explain that."
"Yes, because I don't understand any of that."
"It's much more complicated, but the short version is I felt my daughter needed a mother, so about a year after Elizaveta died, Kris and I met and decided to marry."
"Wait! What?!"
I chuckled, "I promise the whole story if you Match at Moore Memorial!"
"Oh, sure, leave a girl hanging!" Mary exclaimed. "I also should have offered my condolences."
"Thanks."
"So what is that?"
"It's a vascular anomaly where an artery and a vein are directly connected, rather than via capillaries. Without the capillaries, there is no dampening of the pressure of blood moving from the artery to the vein. That deprives the area around it of the usual function of capillaries, which can lead to a buildup of carbon dioxide and a lack of nutrients to cells.
"Over time, it grows into a nidus which has no capillaries and is extremely fragile. When Elizaveta's blood pressure rose, it caused the arteriovenous malformation to expand and bleed due to the abnormally direct connections between high-pressure arteries and low-pressure veins. When that happens within the medulla oblongata, it's routinely fatal due to damage caused to the vagus nerve, which is crucial to circulation and pulmonary function."
"Jesus," Mary breathed.
"Yeah. Nobody looked for it because there were no symptoms until the day she gave birth. And even if they had looked for something, we didn't have the CAT scanner at the time, so they wouldn't have found it. And even if they did find it, there is no way to repair it, even now, almost four years later. Imagine the lawsuit..."
"Yeah, mother dies in childbirth of a 'missed' diagnosis has multi-million-dollar settlement written all over it."
"Exactly. There would have been no legitimate person at whom I could point a finger, but you can be damned sure an attorney would find someone and extract far more than a pound of flesh in such a case. The thing is, I'm reasonably certain that if I weren't a doctor, I wouldn't sue in such a case. But I can sympathize with Ken Webber's girlfriend and family. That said, I will go to the mattresses if someone tries that bullshit again."
"You and Sonny Corleone?" Mary asked.
I chuckled, "Another Godfather fan. My protégée, who is also named Mary, asked me where I was on the rage scale, and while my rage meter pegged at Michael after Sonny at the Causeway, my behavior followed the Don."
"I do want to hear the rest of that story."
"I named my price," I chuckled.
Mary Kealty laughed, "Doctors usually name another price!"
"No cheating here, Miss Kealty."
"Me, either. I'm no prude, but cheating is beyond the pale."
"Indeed."
"You took a chance telling me things that are secret and sharing your story. You must really want me ... for the Match, I mean."
I chuckled, "You are a beautiful young woman, Miss Kealty, but I'm only interested in your skills as a physician."
"As it should be. I'm going to list Moore Memorial first."
"Thank you."
February 18, 1991, McKinley, Ohio
"Mary Kealty and Len Godwin are onside," I said to Dutch on Monday. "I have a reasonably good feeling about Sarah Williams, Christopher Miller, and Jessica Brown. I'll be surprised if any of the rest of our top ten list us anywhere except as a contingency. Of the remaining eight, one or two might list us high enough to Match, but I predict three or four Scrambles, barring some significant change of heart."
"Do you have any ideas?"
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